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MOUD (Medication for Opioid Use Disorder) Best Practices

MOUD (Medication for Opioid Use Disorder) Best Practices

  • MOUD Basics
  • MOUD in Office/Outpatient Settings
  • MOUD in Other Settings
  • Contact ICSI

MOUD Basics

How to Get a Waiver

HHS Announcement of Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder – Changes are Pending Review by New Administration (U.S. Department of Health and Human Services)

We are continuing to watch for updates on the MAT X-waiver, which HHS proposed to be dropped but now is on hold pending review by the new administration.


Physicians

  • Waiver MAT Training for Physicians (Providers Clinical Support System (PCSS))

Advanced Practice Registered Nurses (APRN) (NP/CNM/CNS/CRNA)

  • Waiver Training for Advanced Practice Registered Nurses (APRN) (Providers Clinical Support System (PCSS))
  • Educational Opportunities Available for the Medication Assisted Therapy (MN Board of Nursing)

Physician Assistants (PA) MAT

  • Waiver Training for PAs (Providers Clinical Support System (PCSS))

General/ All Prescriber Training Sites

  • The Addiction Medicine Certification Hub (American Society of Addiction Medicine (ASAM))
  • The ASAM Treatment of Opioid Use Disorder Course (American Society of Addiction Medicine (ASAM))
  • Opioid Education (American Association for the Treatment of Opioid Dependence (AATOD))
  • MAT Waiver Training Resources (MD, APP) (American Academy of Addiction Psychology (AAAP))
  • Fundamentals of Addiction Medicine—40-Hour CME Program (MD, APP, counselors) (American Society of Addiction Medicine (ASAM))
  • Buprenorphine Treatment Curricula (Addiction Technology Transfer Center Network (ATTCN))

Clinical Basics

TIP 63: Medications for Opioid Use Disorder—Executive Summary & Full Document

Substance Abuse and Mental Health Services Administration (SAMHSA)

  • Executive Summary
  • Full Guideline

Topics covered:

  1. Introduction to Medications for Opioid Use Disorder Treatment
  2. Addressing Opioid Use Disorder in General Medical Settings
  3. Pharmacotherapy for Opioid Use Disorder
  4. Partnering Addiction Treatment Counselors With Clients and Healthcare Professionals
  5. Resources Related to Medications for Opioid Use Disorder

The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder—2020 Focused Update

The ASAM guideline includes recommendation on treatment of opioid use disorder and prevention of opioid and prevention of opioid-related overdose deaths.

The ASAM guideline website includes additional information:

  1. Executive Summary
  2. Full guideline
  3. Pocket guide
  4. Link to webinar on OUD treatment for adolescents and young adults

Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) January 2018 (National Institute on Drug Abuse (NIDA))


Buprenorphine (Substance Abuse and Mental Health Services Administration (SAMHSA))


Methadone (Substance Abuse and Mental Health Services Administration (SAMHSA))


Naltrexone (Substance Abuse and Mental Health Services Administration (SAMHSA))


Special Populations

Patients in Pain

The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use – 2015 (American Society of Addiction Medicine (ASAM))

See Part 9 (page 43): Special Populations: Individuals with Pain

TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders – January 2012 (Substance Abuse and Mental Health Services Administration (SAMHSA))

Includes Literature Review and Guidance

Treatment of Pain in Patients Taking Buprenorphine for Opioid Addiction (Palliative Care Network of Wisconsin)

How do I co-manage pain? What meds do I use to manage pain?

ICSI Perioperative Guideline for Patients undergoing Surgery (ICSI)


Benzodiazepines

FDA Drug Safety Communication: FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: careful medication management can reduce risks (Current as of 9/26/17) (Food and Drug Administration (FDA))

Important: Check FDA website frequently for new updates

FDA Requiring Labeling Changes for Benzodiazepines: Boxed Warning to Be Updated to Include Abuse, Addiction and Other Serious Risks (Current as of 9/23/20) (Food and Drug Administration (FDA))

Important: Check FDA website frequently for new updates


Pregnancy

Perinatal Opioid Use Disorder (OUD) ECHO Series (Hennepin Healthcare ECHO)

Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants – January 2018 (Substance Abuse and Mental Health Services Administration (SAMHSA))


Adolescents

TIP 31: Screening and Assessing Adolescents for Substance Use Disorders – June 2012 (Substance Abuse and Mental Health Services Administration (SAMHSA))

Screening Tools for Adolescent Substance Use (National Institute on Drug Abuse (NIDA))

Demystifying Buprenorphine Prescribing for Youth With Opioid Use Disorders (Providers Clinical Support System (PCSS))

Medication-Assisted Treatment: Identifying the Need for Youth and Young Adult-Specific Strategies and Current Initiatives (Webinar & Audio) (Medicaid Innovation Accelerator Program (IAP))

  • Slides
  • Audio

Harm Reduction

Opioid Overdose Prevention

Opioid Overdose Prevention Toolkit (Substance Abuse and Mental Health Services Administration (SAMHSA))

Links to the following:

  1. Opioid Overdose Prevention Toolkit
  2. Opioid Use Disorder Facts
  3. Five Essential Steps for First Responders
  4. Information for Prescribers
  5. Safety Advice for Patients and Families Members
  6. Recovery from Opioid Overdose.

Naloxone (MN Department of Health)

Expanding Naloxone Access for Preventing Opioid Overdose – includes training resources (MN Department of Health)

Naloxone Booklet Infographic (CA Bridge)

Guide to Naloxone Distribution (CA Bridge)

CA focused, however includes useful/helpful tips/tools. Look at MDH Website


Suicidal Thoughts and Behaviors

TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment – October 2015 (Substance Abuse and Mental Health Services Administration (SAMHSA))

Pregnancy

Perinatal Opioid Use Disorder (OUD) ECHO Series (Hennepin Healthcare ECHO)

Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants – January 2018 (Substance Abuse and Mental Health Services Administration (SAMHSA))


Adolescents

TIP 31: Screening and Assessing Adolescents for Substance Use Disorders – June 2012 (Substance Abuse and Mental Health Services Administration (SAMHSA))


Care Team Training

Staff Education

  • TedTalk – Why Do Our Brains Get Addicted, Nora Volkow (TEDMed)
  • PCSS Provider Mentoring Program (Providers Clinical Support System (PCSS))
  • PCSS: Training Videos on Treating Opioid Use Disorder (Providers Clinical Support System (PCSS))
  • Naltrexone Training Part 1 (Providers Clinical Support System (PCSS))
  • Naltrexone Training Part 2 (Providers Clinical Support System (PCSS))
  • Motivational Interviewing for Opioid Use Disorder (Providers Clinical Support System (PCSS))
  • Addressing Stigma Around Addiction (The National Alliance of Advocates for Buprenorphine Treatment (NAABT))
  • It Takes A Village: A Patient’s Journey from Opioid Use Through Recovery (ALLISON JUBA, DO CHI ST. GABRIEL PROJECT ECHO JUNE 3, 2020)

Trauma Informed Care

  • What is Trauma-Informed Care? (Implementation Resource Center): Comprehensive website with tools and other resources on trauma-informed care
  • Trauma Informed Care Resources (Case Western Reserve University): This page contains links to numerous resources on this topic.
  • Trauma-Informed Care Resources (National Council for Behavioral Health (NCBH)): This page contains a link to virtual training on this topic.
  • TIP 57: Trauma-Informed Care in Behavioral Health Services – March 2014 (Substance Abuse and Mental Health Services Administration (SAMHSA)): SAMHSA guidance on addressing impact of trauma on those experiencing it.

MN Community ECHOs
  • CHI St. Gabriels Addiction ECHO (CHI St. Gabriel’s Health – Little Falls, MN)
  • Hennepin Healthcare Opioid ECHO (Hennepin Healthcare – Minneapolis, MN)
  • Midwest Tribal ECHO (Native American Community Clinic (NACC)/Hennepin Healthcare Partnership, Minnesota)
  • Minnesota Viral Hepatitis ECHO (Hennepin Healthcare – Minneapolis, MN)

Regulations

PDMP

  • State PDMP Profiles and Contacts (Prescription Drug Monitoring Program Training & Technical Assistance Center (PDMPTTAC)): Includes a complete and updated contact information on individual states PDMPs and a compilation of state statutes and regulations.
  • Quick Reference Guide – How to Run a Patient Request in Prescription Monitoring Program AWARxE (MN Board of Pharmacy Prescription Monitoring Program (PMP)): This explains how to run a report on a specific patient in the PMP. At a minimum, you must provide: First name, last name, date of birth, prescription fill dates.
  • PDMP Welcome Kit and Information Request Page (MN Board of Pharmacy Prescription Monitoring Program (PMP))

Confidentiality

  • Substance Abuse Confidentiality Regulations (Substance Abuse and Mental Health Services Administration (SAMHSA)): Fact Sheets regarding the Substance Abuse Confidentiality Regulations and FAQ
  • 42 CFR Part 2 for Practices Simplified (Substance Abuse and Mental Health Services Administration (SAMHSA))
  • Substance Abuse Confidentiality and Health Information Exchange FAQs (Substance Abuse and Mental Health Services Administration (SAMHSA)): Information on how to apply the Substance Abuse Confidentiality Regulations to Health Information Exchange (HIE) – FAQs
  • HIPAA Regulations 2004 (U.S. Department of Health and Human Services (U.S. DHHS))

DEA

  • DEA Diversion Control Regulations website (U.S. Drug Enforcement Administration (DEA)): This page includes links to various resources.
  • How to Prepare for a Visit from the Drug Enforcement Agency (DEA) Regarding Buprenorphine Prescribing (Providers Clinical Support System (PCSS))
  • Regulations DEA Agents Refer to during Inspection Visit (Providers Clinical Support System (PCSS)): Go under Clinical Forms then scroll to the bottom of the page and click on “DEA Inspection References” link
  • Drug Accountability Record for Stock Buprenorphine Supplies (Providers Clinical Support System (PCSS)): Go under Clinical Forms then scroll Drug Accountability Forms (if dosing in office) and click on Buprenorphine Stock Accountability Record form link
  • Buprenorphine Prescription Log (Providers Clinical Support System (PCSS))
  • Buprenorphine Record Keeping Requirements (Substance Abuse and Mental Health Services Administration (SAMHSA))

Patient Education

Resources for patients, family and friends

  • Tool for Providers and Patients to Assist Treatment Planning: Decisions in Recovery-Treatment for Opioid Use Disorder (Substance Abuse and Mental Health Services Administration (SAMHSA)): A decision support tool for providers and patients to assist with decision making on treatment of opioid use disorder. The tool is intended to help patients to formulate questions, express concerns during consultation, and make informed decisions. The website includes video clips and worksheets as well as specific topics for providers on how to approach treatment for OUD.
  • Decisions in Recovery: Treatment for Opioid Use Disorders (Substance Abuse and Mental Health Services Administration (SAMHSA))
  • Opioid Addiction Treatment: A Guide for Patients, Families and Friends (American Society of Addiction Medicine (ASAM))
  • Resources for Patients and Families (Family Resource Center)
  • MAT FAQs for Patients (Providers Clinical Support System (PCSS))
  • MAT FAQs for Family Members (Providers Clinical Support System (PCSS))
  • Early Recovery Tips for Patients (Providers Clinical Support System (PCSS))
  • SAMHSA’s National Helpline (Substance Abuse and Mental Health Services Administration (SAMHSA))

Information on Medications

  • Medicines for Treating Opioid Use Disorder: What you need to know when choosing the best treatment for you (CA Bridge)
  • Buprenorphine Information for Patients (Providers Clinical Support System)
  • Buprenorphine Information for Family Members (Providers Clinical Support System)
  • Buprenorphine Fact Sheet – August 2015 (Substance Abuse and Mental Health Services Administration (SAMHSA))
  • Buprenorphine-Naloxone: What You Need to Know (CA Bridge)
  • What is Buprenorphine Treatment Like? (The National Alliance of Advocates for Buprenorphine Treatment (NAABT))
  • Sample Form Patient Responsibilities: Buprenorphine Maintenance Treatment (The Network for the Improvement of Addiction Treatment (NIATx) at the University of Wisconsin–Madison and the Treatment Research Institute (TRI) in Philadelphia): See page 49 for more information
  • Naltrexone Fact Sheet (Providers Clinical Support System (PCSS))


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Contact Us

Institute for Clinical Systems Improvement
8009 34th Avenue South, Suite 1200
Bloomington, MN 55425

(952) 814-7060 (Main)
(952) 858-9675 (Fax)